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Please rate the issues below that represent areas in your marriage that you think require some change.

  Very serious problem Significant problem A problem Slight problem Not a problem or not applicable
1. I would like us to talk to each other more.
2. I would like our sex life to become more satisfying.
3. I would like us to have more independence in this relationship.
4. I would like it if we were more organized.
5. I would like it if my partner spent more time with me.
6a. Our problems center on doing household chores.
6b. I do too much of the work.
7. I would like my partner's relationships with our children to improve.
8. I would like my partner's relationships with our families to improve.
9. I would like us to go to church, mosque, or synagogue together.
10. I would like us to have more fun together on weekends.
11. I would like to have fewer problems with my jealousy.
12. I would like to have fewer problems with my partner's jealousy.
13. I would like my partner to have fewer problems with alcohol and drugs.
14. I would like us to have some more friends in common.
15. I would like to be consulted on important decisions.
16. I would like my partner to show more physical affection toward me.
17. I want us to go out on more "dates" together.
18. I would like my partner to watch less television and talk to me more instead.
19. I want us to make love more often.
20. I want more help with the finances.
21. I would want to receive more appreciation for what I do.
22. There's an affair that we need help getting over.
23a. I would like for us to have fewer problems with in-laws.
23b. I would like to get more support from my partner about in-law problems.
24. I would like us to agree more about saving money.
25. I would like it if our lives were less chaotic.
26. I would like it if we had fewer disagreements about spending money.
27. I would like our lives to be less stressful.
28. I would like us to have more fun than we do.
29. We don't have enough of a social life.
30. I would like us to talk over a major upcoming decision.
31. I don't feel my partner listens to me when I am upset.
32. I don't feel supported in this relationship.
33. I don't feel that my partner is very affectionate.
34. I would like to have a (or another) child.
35. We don't take enough holidays.
36. Other (specified below)
37. Other (specified below)
Based on the Gottman Areas of Change Checklist: Solvable Problems
 

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